Provider Demographics
NPI:1265429963
Name:KUTNIKAR, DHAYA N (MD)
Entity type:Individual
Prefix:MRS
First Name:DHAYA
Middle Name:N
Last Name:KUTNIKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 LAMY LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3739
Mailing Address - Country:US
Mailing Address - Phone:318-388-5383
Mailing Address - Fax:318-388-5779
Practice Address - Street 1:1805 LAMY LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3739
Practice Address - Country:US
Practice Address - Phone:318-388-5383
Practice Address - Fax:318-388-5779
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.023401207Q00000X
LA023401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1564869Medicaid
LA1564869Medicaid
LA5E793Medicare ID - Type Unspecified